13例儿童重度肾挫裂伤的临床研究  

Clinical study on 13 cases with high-grade pediatric blunt renal trauma

作　　者：罗添华[1] 张旭辉[1] 王计文[1] 孟庆明[1] 陈柏峰[1] 张小学[1] LUO Tianhua;ZHANG Xuhui;WANG Jiwen;MENG Qinming;CHEN Baifeng;ZHANG Xiaoxue(Department of Pediatric Surgery,Shanxi Children＇s Hospital,Taiyuan,030013,China)

机构地区：[1]山西省儿童医院泌尿外科,太原030013

出　　处：《临床泌尿外科杂志》2018年第9期751-754,共4页Journal of Clinical Urology

摘　　要：目的:分析重度闭合性肾挫裂伤患儿的临床资料,积累其早期并发症的诊断和治疗经验。方法:回顾性分析2009~2018年经我院诊治的13例重度肾挫裂伤(Ⅳ度10例,Ⅴ度3例)患儿的临床资料。男11例,女2例,年龄2~12岁。肾盂破裂尿外渗4例,肾盂输尿管交界处离断3例,肾实质全层裂伤3例,肾蒂损伤3例。分析所有病例的彩超及CT影像特征,手术干预的原因、方式、时机以及预后。结果:肾盂破裂尿外渗彩超表现为肾脏中下极回声不均区,其内出现纤维分隔,尿囊扩大可致肾脏受压萎缩,但始终无肾积水。而输尿管断裂则表现为肾脏下极囊性肿物合并肾积水,增强CT提示尿外渗。肾动脉阻塞增强CT显示动脉期肾皮质无强化。4例保守治疗痊愈;4例行肾切除术;3例行尿囊引流术;1例行肾盂输尿管再吻合术;1例行输尿管逆行插管造影术。所有重度肾挫裂伤患者无一例死亡,无肾周感染或者积脓。结论:彩超结合增强CT是诊断儿童重度肾挫裂伤早期并发症的重要手段。输尿管逆行插管造影可协助鉴别有无输尿管断裂。根据病情适时采取手术探查,以避免可能发生的尿囊性肾萎缩和输尿管断裂所致的无功能肾。Objective：To analyze the clinical data of high-grade blunt renal trauma in children,and enrich the experience of the diagnosis and management of its short complications.Method：We retrospectively reviewed 13 children presenting with gradeⅣ and Ⅴ blunt renal trauma between 2009 and 2018.There were 11 males and 2 females with a minimum age of 2 years old and a maximum age of 12 years old.There were 4 cases with urinary extravasation of renal pelvis,3 cases with ureteropelvic junction,3 cases with full-thickness of renal parenchyma and 3 cases with renal pedicle injury.We studied characteristics on ultrasonogram,computerized tomography,reasons for intervention,type and timing of surgery and prognosis.Result：The urinary extravasation of the renal pelvis was characterized by uneven echogenicity in the middle and lower poles of the kidney.The enlargement of the allanto can cause the kidney to be atrophied,but there was no hydronephrosis.The ureteral rupture was characterized by the lower cystic mass of the kidney combined with hydronephrosis,and enhanced CT indicates urinary extravasation.And if renal artery obstruction existed,enhanced CT showed no enhancement of the renal cortex in the arterial phase.Four patients underwent conservative treatment;four patients underwent nephrectomy;three patients underwent peritoneal drainage;one patient underwent ureteropelvic anastomosis;one patient underwent ureteral retrograde intubation angiography.There was no death in the group of severe renal trauma.No perirenal infection or empyema was found.Conlusion：Color Doppler ultrasound combined with enhanced CT is an important means to diagnose early complications of severe renal contusion in children.Retrograde intubation angiography can help identify the presence or absence of ureteral rupture.Surgical exploration should be performed according to the condition to avoid possible allantoic renal atrophy and non-functional kidney caused by ureteral rupture.

关 键 词：儿童 重度肾挫裂伤 早期并发症 诊断 治疗 

分 类 号：R699.2[医药卫生—泌尿科学]